013423896-9-6-2023-02-CC-RDUT-CVENLW-20230906103415

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 013423896
Report Date: 09/06/2023
Date Signed: 09/06/2023 10:34:21 AM

Document Has Been Signed on 09/06/2023 10:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME:	TITUS, ANGELA		FACILITY NUMBER:	013423896
ADMINISTRATOR:	TITUS, ANGELA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(209) 603-8187
CITY:	OAKLAND	STATE: CA	ZIP CODE:	94612
CAPACITY:	14	CENSUS: 0	DATE:	09/06/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Angela Titus		TIME COMPLETED:	10:45 AM

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On 9/6/2023, Licensing Program Analyst (LPA) Randall Dunevant conducted an announced Pre-licensing inspection and met with applicant Angela Titus. LPA disclosed the purpose of the inspection and was granted entry into the facility by the applicant. Residing in the home is the Applicant. The facility was toured to conduct a health and safety inspection. The Applicant plans to operate Monday through Friday from 6am-6pm.

This home is a single-story loft style condo consisting of 1 bedroom, 2 bathrooms, great room, kitchen/dining. The home was observed to be neat and clean with heating and ventilation for safety and comfort of the children.

On-limit-areas are: The great room, kitchen/dining, downstairs bathroom.

Off-limit-areas are: The upstairs bedroom and bathroom.

Outdoor play area: parks within the local area

Isolation area: In the front of the great room on the couch

There are age-appropriate toys which are observed to be safe, clean and in good repair. The Applicant plans on providing Breakfast, Lunch and two snacks to the children. There are no bodies of water or pools accessible to children in care during today’s inspection. LPA did not observe any hazardous materials or toxins accessible to children during today’s inspection. Per Applicant there are no firearms in the home. The Applicant will not be providing Overnight Care. Off limits areas are made inaccessible by closed and/or locked doors, gates, and visual supervision.

The home has a fully charged 2A10BC fire extinguisher next to the entrance, a working smoke detector in the kitchen, and a plug-in carbon monoxide detector in the kitchen, and a working telephone. The Applicant does not have Liability Insurance.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Randall Dunevant	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TITUS, ANGELA	FACILITY NUMBER: 013423896
	VISIT DATE: 09/06/2023

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Applicant was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5-days or, if the penalty is for a repeat violation, for a maximum of 30-days per person will be assessed if this regulation is violated.

RENTS/LEASES THE HOME: Applicant provided proof of control of property.

Because applicant rents/leases the home, proof of landlord notification is required. The LPA observed the Property Owner/Landlord Notification form (LIC9151) that the applicant confirms was provided to the property owner/landlord. The applicant obtained a signed Property Owner/Landlord Consent form (LIC 9149).

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA reviewed with applicant the LIC 311D, Forms/Records to Keep in Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. Entrance Checklist was provided to the applicant. PIN 22-05-CCP Page Eight

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep, as an additional resource. LPA also informed applicant of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/, and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Randall Dunevant	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND CC RO, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: TITUS, ANGELA	FACILITY NUMBER: 013423896
	VISIT DATE: 09/06/2023

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The California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ.

Applicant was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&Rs) throughout California.

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-carelicensing/subscribe and select the Child Care option to receive email communication.

A notice of site visit was given to applicant and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Licence will be issued effective today

Exit interview conducted and report was reviewed with the Angela Titus.

SUPERVISOR'S NAME: Loretta Dyson	TELEPHONE: (510) 695-0243
LICENSING EVALUATOR NAME: Randall Dunevant	TELEPHONE: (510) 725-2063
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC809 (FAS) - (06/04)

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